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Sunday, October 2, 2011

Two Liters Too Few.

Angueth came in barely conscious. But by the time I was called, my translator had little time to do much more than learn her name and get her to lie down on the bed. It was a busy night.

So I busied myself with fundal heights and heart tones while he asked her more questions.

“Ask her how long she’s been sick like this,” I instructed my translator.
She responded but I couldn’t understand her words. She was slurring them.
“Is she drunk?” I asked again, confused and not a little worried, “Or has she had a stroke?”

The man who brought her in, didn’t know so he asked her daughter. There was a brief discussion, during which it became clear that this man wasn’t her husband. He may have been a neighbor or a random stranger. But he wasn’t family.

“The girl says she doesn’t drink,” I was informed.

Angueth was barely hanging on at this point. Every few minutes she’d slip from consciousness and I’d try to pull her back.

Limp and cold, her extremities were swollen and her mucosa was white. She was severely anemic. I screened her for malaria symptoms.

She’d had all the major symptoms for some time, but she’d not been able to talk right for three days.

“This is outside of my scope of practice,” I explained to my translator, “Please get Dennis. I need his help.”

He grabbed the flashlight and left in a hurry, leaving me with Angueth, the Good Samaritan and a handful of kids.

Three to be precise.

Her eldest looked to be about 10 years old; the other two were both under 5. And all three sat quietly on the bench in the hall.

I continued checking her vitals while I waited.

Search as I might, I found no heart tones and eventually gave up. She looked to be about 7-8 months pregnant.

“My lower abdomen hurts,” she mumbled softly while rubbing the spot.
“Is it a contraction?” I asked in Dinka.
“Yes, it hurts. It hurts.”

Although I could not see or feel any contractions, I suspected her body might be delivering in an effort to save her life. So I did a vaginal exam.

Sure enough she was dilating. She was already 5-6 cm along.

Dennis arrived and I filled him in. He assured me that she hadn’t had a stroke but was in the late stage of severe anemia. Surprisingly her blood pressure was stable. So we started her on antimalarials and admitted her for labor.

Late as it was, there was no hope of getting her to Wau for a transfusion. Plus the Good Samaritan had quietly slipped away, and we had no way of contacting her family.

When I told her that she was very sick and was delivering early, she wasn’t surprised. But when I told her that her baby was no longer alive it took her a while to come to terms.

“So my baby is coming?” she asked, bubbles forming at her mouth.
“Yes,” I said looking at her full in the face. Her eyes searched mine in an effort to understand.
“When he comes. Will he be alive or dead?” she continued on.
“Your baby will be dead.”
Whimpering softly in response, she closed her eyes.

I think she wanted to say more, but the effort to speak was too great. Staying conscious was a hard enough.

Margaret took over her care in the night. She told me that Angueth’s labor progressed naturally, and a few hours later she delivered a girl. She was dead but hadn't been for long. Fortunately, Angueth lost only the slightest amount of blood, and her blood pressure remained stable throughout.

The following morning when I went to check on her, I was surprised to find her fast asleep. But when I tried to rouse her, she was completely unresponsive.

Although she’d been assessed shortly before by our night staff, it was clear the vitals were off. So I took them again. And sure enough, I was right.

She was unconscious and in shock.

With cold extremities, high pulse, and blood pressure bottoming out, I called for re-enforcements. First I called Tom, who listened to her chest for the sound of heart failure in the form of fluid build up. But eventually announced that it was out of our hands, saying she needed a blood transfusion.

Yes. That was clear.

Then I called Dennis, who helped me elevate her legs and suggested I give her Hemosele (a blood replacement IV fluid) to see if her blood pressure might at least stabilize. It was 68/42.

Blissfully unaware of the seriousness of the situation, two of her three children napped on our porch while the eldest went to get porridge.

When she returned I asked her to find an uncle or an aunt. Anyone. I told her that I needed to speak to them urgently. Could she do that for me?

Eager to help, she smiled sweetly and left right away. And I returned to her mother. I continued to monitor her vitals, but the fluids didn’t help.

Her blood pressure continued to plummet, and her breathing became more rapid and hoarse. A choking rattle filled the room as I watched... and counted. She was up to 60 respirations a minute.

A few minutes later, she passed away, shedding two tears without waking. They streamed down her cheeks and onto the bed.

Then the rattled ceased.

At the sight of her tear-stained face, I couldn’t hold back my own. And I mourned for this stranger as if she were my sister, grateful no one was there to watch.

A few hours later, Albino was able to track down her brother and uncle. They hadn’t even heard she was ill. Apparently her husband left some time ago. She lived alone.

Her family gathered around and I told them the story of her death. They were sad but thankful to have a few answers. Then one of our guards walked her children home while the rest of us placed her in the ambulance.

Rigor mortis had already set in.

As I helped lift her body into the vehicle, I had to step over two shovels and a pick. --How long will it take them to dig her grave?

Lord, please teach us how to do blood transfusions and send us the equipment. I’m tired of watching these women die for the lack of two liters of blood. Better still... Lord, send them to us for prenatals.

And if by some miracle any reader out there knows how to do transfusions and can teach us what kind of equipment we need, I want to chat! Write me in the comment section.

I’m praying that God will send us the equipment and the expertise to do transfusions. Will you pray with me?